Background: Over the past decade there has been increased recognition of the dangers associated with inpatient management of diabetes insipidus (DI) and omission of desmopressin leading to hypernatremia. In May 2009 a patient died from diabetes insipidus mismanagement in a London hospital. An NHS England patient safety alert was issued in 2016 highlighting this risk.
Method: Inpatients with a serum sodium of 155 mmol/l or greater were prospectively identified on a daily basis over a period of six months. A semi-automated report was generated but not circulated or acted upon at the time. After 6 months the reports were retrospectively reviewed to assess the outcomes of these patients and to assess whether real time review of this data would have led to a change in management. We also assessed: cause of hypernatraemia, action taken, involvement of the endocrine team and outcome including 30 day mortality.
Results: After excluding paediatric cases and patients in intensive care: 87 patients were identified over 6 months. The age range was 3392 with mean age 72. The serum sodium ranged from 155178, mean 160 mmol/l. 2% of the cohort (2/87) represented decompensated diabetes insipidus. The mortality of the overall cohort was high, 48% (42/87) died either during the admission or within 30 days of discharge. 26% (23/87) of cases were referred to the endocrine team for inpatient review.
Discussion: Inpatient severe hypernatraemia (Na≥155) is uncommon but the associated mortality is extremely high. Automated surveillance would alert the endocrine team to 100% of patients with severe hypernatraemia, as opposed to the 26% of cases currently referred. Annually a small number of cases of decompensated inpatient diabetes insipidus could potentially be identified by this method of surveillance, which may have patient safety benefits.